STUDY OF EFFICIENCY OF DEXAMETHASONE AS PREEMPTIVE ANALGESIA IN PATIENTS UNDERGOING TOTAL ABDOMINAL HYSTERECTOMY UNDER GENERAL ANESTHESIA: A RETROSPECTIVE OBSERVATIONAL STUDY

Abstract

Background: Postoperative pain is considered as a reason for the patient’s delay in discharge and disability aggravation. Dexamethasone, as a part of multimodal analgesia (preemptive analgesia), can reduce postoperative pain because of its anti-inflammatory properties.

Objectives: To see the effect of dexamethasone on early acute(0-4hours) and late acute postoperative pain (6, 12, 24 hours) using visual analog scale and analgesic consumption up to 24hrs, the incidence of nausea and vomiting and adverse effects like postoperative infection (wound, urinary tract, and pneumonia), hyperglycemic events, delayed healing, and pruritus.

Study design:  Retrospective observational study              

Participants: Patients (40-65years) undergoing TAH for benign gynecological conditions with ASA 1 and 2.

 Methods: 80 patients were enrolled and retrospectively grouped into 4 groups (A, B, C, D) on the basis of a dose of dexamethasone received before induction. Group A(n=20)-low dose (0.1mg/kg); Group B(n=20)-intermediate dose (0.12-0.2 mg/kg); Group C(n=20)- high dose(>0.2mg/kg) and Group D(n=20)- no dexamethasone. The effect of dexamethasone on postoperative pain, nausea and vomiting, and other side effects were noted. Rescue Analgesic was given as im ketorolac (30mg) on demand.

Results: All groups were homogenous with respect to demographic data. There was a statistically significant difference(p<0.05) in VAS for early acute postoperative pain among these groups(0-4hours) with maximum VAS in group D and minimum in group C. There was a statistically significant difference(p<0.05) in VAS for late acute postoperative pain among these groups(6-24hours) between group A and B, A and C, B and D, C and D at all times. VAS was comparable between groups A and D, and B and C for late postoperative pain. There was the least analgesic consumption in group C but it was comparable with group B. There was a statistically significant difference in blood sugar levels (mg/dl) among these groups up to 12hrs, after that no statistically significant difference at 16, 20, 24 hours till hospital stay. No other significant adverse effects were noted.

Conclusion: It was concluded that intermediate and high dose range of dexamethasone but not the low dose range, given preoperatively produces better analgesia in the postoperative period. However, there was no statistically significant difference in VAS score between intermediate and high dose range of dexamethasone for late acute postoperative pain.

Implications: It is better to give an intermediate dose range (0.12-0.2mg/kg) of dexamethasone as a preemptive analgesic as there was no significant difference in VAS score and analgesic consumption between intermediate and high dose range of dexamethasone groups for late acute postoperative pain.